* Parasternal long axis view 에서 수축기에 doming 으로 관찰됨
Cusp calcification and thickening
Cusp motion limitation and doming
LVH
Echocardiogram in parasternal long axis view showing calcific aortic valve which domes in systole / https://johnsonfrancis.org/
Diastolic frame in aortic stenosis from parasternal long axis view showing aortic valve in closed position / https://johnsonfrancis.org/
* Parasternal short axis view 에서 물고기 입 모양
Cusp calcification and thickening
Cusp motion limitation
Commissureal fusion (in Rheumatic AS)
Parasternal short axis view at the level of the aortic valve / https://johnsonfrancis.org/
* Rheumatic AS 와 Degenerative AS 의 차이
Rheumatic AS 의 경우 commissural fusion, Multivalvular involvement
MV 를 더 먼저 침범하기 때문에 같이 involve 하는 경우가 많다.
촛농이 흘러내리는 모양
In a parasternal mid-systolic short-axis view, calcific aortic stenosis is characterized by fibro-calcific masses on the aortic side of the leaflet that result in increased leaflet stiffness without commissural fusion. Calcific shadowing and reverberations limit image quality. With a congenital bicuspid valve, the two leaflets (with a raphe in the anterior leaflet) open widely in systole. The diagnostic features of rheumatic stenosis are commissural fusion and mitral valve involvement, with the characteristic triangular aortic valve opening in systole. The unicupsid valve has only one point of attachment (at the 6 o’clock position) with a funnel-shaped valve opening. / https://thoracickey.com/valvular-stenosis/
* Doppler Examination
https://thoracickey.com/valvular-stenosis/
* CW doppler
- AS severity 평가시 중요
- 그림만 잘 그려주면 Peak pressure gradient, Mean pressure gradient 를 산출해 준다.
- Angle dependency 가 있으므로, 여러 방향에서 측정하여 도플러의 방향이 대동맥판을 지나는 혈류와 최대한 평행이 되도록 해야한다.
* LVOT obstruction 의 감별진단
- Valvular Aortic stenosis
- Subaortic membrane (Membrane 이나 web 이 생겨 obstruction)
- HCMP
Different types of LV outflow obstruction. Examples of the shape of the CW Doppler velocity curve in valvular aortic stenosis, fixed subvalvular obstruction due to a subaortic membrane, and dynamic obstruction due to hypertrophic cardiomyopathy. Note that the CW curves for subvalvular and valvular aortic stenosis are similar, although coarse fluttering of the valve with subvalvular obstruction results in a “rough” appearance of the systolic velocity curve. These can be distinguished by 2D and color flow imaging. The shape of the curve with dynamic obstruction is distinctly different, with the velocity peaking in late systole. / https://thoracickey.com/valvular-stenosis/
* High velocity systolic jets that may be mistaken for AS
